Vielsmeier Veronika, Schecklmann Martin, Schlee Winfried, Kreuzer Peter M, Poeppl Timm B, Rupprecht Rainer, Langguth Berthold, Lehner Astrid
Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany.
Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
Front Neurosci. 2018 Feb 20;12:68. doi: 10.3389/fnins.2018.00068. eCollection 2018.
UNLABELLED: While brain stimulation techniques have been examined as treatment options for chronic tinnitus for many years, they have recently been extended to multimodal treatment approaches. As chronic tinnitus is often accompanied by comorbid muscular tension in the neck and back, we performed a one-arm pilot study to explore the feasibility of a new multimodal treatment approach. In detail, repetitive peripheral magnetic stimulation (rPMS) of the back was performed before and after each session of repetitive transcranial magnetic stimulation (rTMS) of the brain. Data of 41 patients were analyzed, all of which were treated with ten sessions of rTMS of the left prefrontal and left temporoparietal cortex followed by rPMS of the neck and back muscles. Tinnitus severity was measured using the tinnitus questionnaire (TQ). Neck pain was assessed using the neck pain and disability scale (NPAD). The new treatment approach was feasible and well accepted by the majority of patients. However, the overall patient group did not improve significantly in either of the questionnaires. If patients were divided in different subgroups depending on whether they were suffering from neck pain or somatosensory tinnitus, explorative tests suggested differential effects: patients with both neck pain and somatosensory tinnitus had better outcomes than patients without those conditions or with neck pain only. This was true for both the TQ and the NPAD. This effect was of transient nature though: the TQ score went back to its baseline level after a follow-up period of 12 weeks. Based on our results we recommend that in studies that investigate tinnitus treatments targeting somatosensory afferents patients should be stratified according to somatic co-morbidities and somatosensory influence on the tinnitus percept. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov, NCT02306447.
未标注:虽然多年来一直将脑刺激技术作为慢性耳鸣的治疗选择进行研究,但最近已将其扩展到多模式治疗方法。由于慢性耳鸣常伴有颈部和背部的合并肌肉紧张,我们进行了一项单臂试点研究,以探索一种新的多模式治疗方法的可行性。具体而言,在每次脑部重复经颅磁刺激(rTMS)前后,对背部进行重复外周磁刺激(rPMS)。分析了41例患者的数据,所有患者均接受了10次左侧前额叶和左侧颞顶叶皮质的rTMS治疗,随后对颈部和背部肌肉进行rPMS治疗。使用耳鸣问卷(TQ)测量耳鸣严重程度。使用颈部疼痛和残疾量表(NPAD)评估颈部疼痛。这种新的治疗方法是可行的,并且大多数患者都能很好地接受。然而,在两份问卷中,整个患者组均未出现显著改善。如果根据患者是否患有颈部疼痛或体感耳鸣将其分为不同亚组,探索性测试显示出不同的效果:同时患有颈部疼痛和体感耳鸣的患者比没有这些症状或仅患有颈部疼痛的患者有更好的治疗效果。TQ和NPAD均是如此。不过,这种效果是短暂的:在12周的随访期后,TQ评分回到了基线水平。根据我们的研究结果,我们建议在调查针对体感传入神经的耳鸣治疗的研究中,应根据躯体合并症和体感对耳鸣感知的影响对患者进行分层。 临床试验注册:www.clinicaltrials.gov,NCT02306447。
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